CPT 99310E&M

Sbsq nf care high mdm 45

CPT code 99310 covers a follow-up visit to a patient in a nursing facility or skilled nursing facility when the patient's medical condition requires complex decision-making. This is the highest level of subsequent nursing facility care, used when patients are moderately to highly complex or unstable.

Showing rates for

National Average

Base Medicare rate

$148.47

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.8

PE RVU (NF)

1.59

MP RVU

0.2

Total RVU

4.59

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document total time spent on the date of encounter (typically 45+ minutes for 99310) including bedside care, chart review, and care coordination
Impact: Time-based documentation provides alternative pathway when MDM alone may be challenged; protects $148.47 reimbursement during audits
Clearly document at least two of three MDM elements at high level: extensive problems addressed (high risk), extensive data review, or high risk management options
Impact: Meeting high MDM criteria justifies 99310 vs 99309 ($111.46), capturing additional $37.01 per visit
Bill only one nursing facility E&M code per patient per calendar date, even if multiple visits occur
Impact: Prevents automatic denials; Medicare allows only one SNF E&M per day regardless of circumstances
Verify patient status is 'subsequent' not 'initial' or 'discharge'; initial visits require 99304-99306, discharge requires 99315-99316
Impact: Code selection errors trigger denials and delays; 99304 (initial comprehensive) pays $219.44 when appropriate
Document medication reconciliation and review of diagnostic test results explicitly in the medical record
Impact: These elements contribute to 'extensive data' category for MDM scoring; strengthens audit defense for high-level coding
For Medicare Part B billing, ensure the patient is not in a Part A SNF benefit period, as Part A covers physician services during covered stays
Impact: Billing during Part A coverage results in 100% denial; verify coverage status before submitting claims to avoid $148.47 write-off

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Frequently asked questions

What is the difference between CPT 99310 and 99309?

CPT 99310 requires high medical decision-making complexity or 45 minutes of total time, while 99309 requires moderate MDM or 35 minutes. The 99310 reimbursement is $148.47 compared to approximately $111.46 for 99309. Use 99310 when managing highly complex patients with significant risk, extensive data review, or multiple chronic conditions requiring intensive management.

How much does Medicare pay for CPT code 99310 in 2025?

Medicare pays $148.47 for CPT 99310 in 2025 based on the national average non-facility rate. This rate is calculated using 4.59 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary slightly based on geographic locality adjustments.

Can I bill 99310 for a nursing home visit if I spend less than 45 minutes?

Yes, you can bill 99310 with less than 45 minutes if you meet high medical decision-making criteria based on the complexity of problems addressed, data reviewed, and risk of management options. Time-based coding (45+ minutes) is an alternative pathway, not a requirement, under the 2021 E&M guidelines. Document whichever pathway you're using.

What RVU value is assigned to CPT 99310?

CPT 99310 has a total RVU of 4.59 for 2025, consisting of 2.8 work RVUs, 1.59 practice expense RVUs, and 0.2 malpractice RVUs. This is the same for both facility and non-facility settings since nursing facility visits are considered facility services.

How often can I bill 99310 for the same patient?

You can bill 99310 as frequently as medically necessary and documented, but only once per calendar date per patient. There is no Medicare limitation on frequency for subsequent nursing facility visits as long as each encounter is medically necessary, properly documented, and meets the criteria for the level of service billed.

Can nurse practitioners and physician assistants bill CPT 99310?

Yes, nurse practitioners and physician assistants can bill 99310 when performing services within their scope of practice and state regulations. They bill under their own NPI and typically receive 85% of the physician fee schedule amount unless they work in a rural health professional shortage area or under certain state-specific arrangements.

What documentation supports high complexity medical decision-making for 99310?

High MDM requires documenting at least two of three elements: (1) high-risk problems such as severe exacerbation of chronic illness or acute illness with systemic symptoms, (2) extensive data review including independent interpretation of tests or discussion with external providers, or (3) high-risk management decisions like initiation of therapy with significant risk or consideration of hospitalization. Include specific clinical details, not just diagnosis lists.